OBJECTIVES: Based on a recent indirect treatment comparison, golimumab showed comparability in efficacy and safety to infliximab and superiority to adalimumab in efficacy in terms of sustaining clinical outcomes. For this reason, a cost-effectiveness (CE) analysis comparing the three anti-TNF-α agents was conducted. METHODS: A Markov model was created to simulate patients over 10 years. The first administered intervention was any of the three biologics. Health states included clinical remission, clinical response, and relapse. Upon relapsing with the administered biologic, patients were assumed to transition into ‘relapse management’. Patients would then undergo colectomy and enter ‘post-colectomy remission’. Utilities were assigned separately for states before and after colectomy. Canadian cost estimates were used. Uncertainty around transition probabilities and cost estimates were incorporated. Sensitivity analyses included a societal perspective, varying discount rates, and time horizons, and ‘real world’ transition probabilities. Measures included total cost and utility over 10 years, mean incremental cost and utility per year, incremental CE ratios (ICERs), CE acceptability curves (CEACs) for golimumab and the CE frontier for all biologics. RESULTS: In all analyses, golimumab yielded the lowest ICER. In the base case analysis, golimumab, infliximab, and adalimumab were associated with ICERs of approximately $40,000/QALY, $80,000/QALY, and $100,000/QALY, respectively. The CEAC for golimumab showed that a willingness-to-pay threshold (WTPs) of $100,000/QALY was associated with a ~90% probability of being cost-effective. The cost-effectiveness frontier demonstrated that WTP thresholds greater than $25,000 showed that golimumab had the greatest probability of being cost-effective. Golimumab and infliximab displayed extended dominance compared to adalimumab. Sensitivity analysis taking a societal perspective or using ‘real world’ transition probabilities reduced the ICERs by 20-40% for all biologics. CONCLUSIONS: Overall golimumab provides a cost-effective treatment option for patients who have had an inadequate response to conventional therapy for moderately to severely active ulcerative colitis.